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A randomized sham-controlled trial on the effect of continuous positive airway pressure treatment on gait control in severe obstructive sleep apnea patients. Sci Rep 2021; 11:9329. [PMID: 33927278 PMCID: PMC8085224 DOI: 10.1038/s41598-021-88642-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 04/09/2021] [Indexed: 11/21/2022] Open
Abstract
To determine the effect of continuous positive airway pressure (CPAP), the gold standard treatment for obstructive sleep apnea syndrome (OSAS), on gait control in severe OSAS patients. We conducted a randomized, double-blind, parallel-group, sham-controlled monocentric study in Grenoble Alpes University Hospital, France. Gait parameters were recorded under single and dual-task conditions using a visuo-verbal cognitive task (Stroop test), before and after the 8-week intervention period. Stride-time variability, a marker of gait control, was the primary study endpoint. Changes in the determinants of gait control were the main secondary outcomes. ClinicalTrials.gov Identifier: (NCT02345694). 24 patients [median (Q1; Q3)]: age: 59.5 (46.3; 66.8) years, 87.5% male, body mass index: 28.2 (24.7; 29.8) kg. m−2, apnea–hypopnea index: 51.6 (35.0; 61.4) events/h were randomized to be treated by effective CPAP (n = 12) or by sham-CPAP (n = 12). A complete case analysis was performed, using a mixed linear regression model. CPAP elicited no significant improvement in stride-time variability compared to sham-CPAP. No difference was found regarding the determinants of gait control. This study is the first RCT to investigate the effects of CPAP on gait control. Eight weeks of CPAP treatment did not improve gait control in severe non-obese OSAS patients. These results substantiate the complex OSAS-neurocognitive function relationship.
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Ren H, Jiang X, Xu K, Chen C, Yuan Y, Dai C, Chen W. A Review of Cerebral Hemodynamics During Sleep Using Near-Infrared Spectroscopy. Front Neurol 2020; 11:524009. [PMID: 33329295 PMCID: PMC7710901 DOI: 10.3389/fneur.2020.524009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Accepted: 10/26/2020] [Indexed: 11/13/2022] Open
Abstract
Investigating cerebral hemodynamic changes during regular sleep cycles and sleep disorders is fundamental to understanding the nature of physiological and pathological mechanisms in the regulation of cerebral oxygenation during sleep. Although sleep neuroimaging methods have been studied and have been well-reviewed, they have limitations in terms of technique and experimental design. Neurologists are convinced that Near-infrared spectroscopy (NIRS) provides essential information and can be used to assist the assessment of cerebral hemodynamics, and numerous studies regarding sleep have been carried out based on NIRS. Thus, a brief historical overview of the sleep studies using NIRS will be helpful for the biomedical students, academicians, and engineers to better understand NIRS from various perspectives. In this study, the existing literature on sleep studies is reviewed, and an overview of the NIRS applications is synthesized and provided. The paper first reviews the application scenarios, as well as the patterns of fluctuation of NIRS, which includes the investigation in regular sleep and sleep-disordered breathing. Various factors such as different sleep stages, populations, and degrees of severity were considered. Furthermore, the experimental design and signal processing, as well as the regulation mechanisms involved in regular and pathological sleep, are investigated and discussed. The strengths and weaknesses of the existing NIRS applications are addressed and presented, which can direct further NIRS analysis and utilization.
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Affiliation(s)
- Haoran Ren
- The Center for Intelligent Medical Electronics, School of Information Science and Technology, Fudan University, Shanghai, China
| | - Xinyu Jiang
- The Center for Intelligent Medical Electronics, School of Information Science and Technology, Fudan University, Shanghai, China
| | - Ke Xu
- The Center for Intelligent Medical Electronics, School of Information Science and Technology, Fudan University, Shanghai, China
| | - Chen Chen
- The Center for Intelligent Medical Electronics, School of Information Science and Technology, Fudan University, Shanghai, China
| | - Yafei Yuan
- The Center for Intelligent Medical Electronics, School of Information Science and Technology, Fudan University, Shanghai, China
| | - Chenyun Dai
- The Center for Intelligent Medical Electronics, School of Information Science and Technology, Fudan University, Shanghai, China
| | - Wei Chen
- The Center for Intelligent Medical Electronics, School of Information Science and Technology, Fudan University, Shanghai, China.,Human Phenome Institute, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Medical Imaging Computing and Computer Assisted Intervention, Shanghai, China
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Tabone L, Khirani S, Amaddeo A, Emeriaud G, Fauroux B. Cerebral oxygenation in children with sleep-disordered breathing. Paediatr Respir Rev 2020; 34:18-23. [PMID: 31753753 DOI: 10.1016/j.prrv.2019.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 10/15/2019] [Indexed: 10/25/2022]
Abstract
Sleep-disordered breathing (SDB) is associated with neurocognitive and behavioral dysfunction, and structural brain abnormalities. Near infrared spectroscopy allows a continuous and non-invasive monitoring of brain tissue oxygenation, giving insight in some pathophysiological mechanisms potentially associated with SDB-related neurocognitive dysfunction. The present review summarizes the finding of studies describing brain tissue oxygenation in adults and children with SDB. Contrary to adults, mean nocturnal tissue oxygenation index (TOI) during sleep does not seem to be different in children with SDB as compared to healthy controls. During respiratory events such as apnoeas and hypopnoeas, the decrease in TOI precedes the peripheral, systemic desaturation. The decrease in TOI has been shown to be greater during apnoeas as compared to hypopnoeas, during rapid-eye movement sleep as compared to other sleep stages, in younger children as compared to their older counterparts, and in those with a high apnoea-hypopnoea index as compared with a low apnoea-hypopnoea index. Studies analyzing the association between repetitive changes in TOI and neurocognitive and behavioral dysfunction may help to decipher the pathophysiology of neurocognitive dysfunction associated with SDB in children.
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Affiliation(s)
- Laurence Tabone
- Department of Pediatrics, Pediatric Intensive Care Unit, CHU Sainte-Justine, Université de Montréal, Montreal, Qc, Canada; Université de Paris, VIFASOM, F-75004 Paris, France
| | - Sonia Khirani
- Université de Paris, VIFASOM, F-75004 Paris, France; Pediatric Noninvasive Ventilation and Sleep Unit, AP-HP, Hôpital Necker Enfants-Malades, F-75015 Paris, France; ASV Santé, Gennevilliers, France
| | - Alessandro Amaddeo
- Université de Paris, VIFASOM, F-75004 Paris, France; Pediatric Noninvasive Ventilation and Sleep Unit, AP-HP, Hôpital Necker Enfants-Malades, F-75015 Paris, France
| | - Guillaume Emeriaud
- Department of Pediatrics, Pediatric Intensive Care Unit, CHU Sainte-Justine, Université de Montréal, Montreal, Qc, Canada
| | - Brigitte Fauroux
- Université de Paris, VIFASOM, F-75004 Paris, France; Pediatric Noninvasive Ventilation and Sleep Unit, AP-HP, Hôpital Necker Enfants-Malades, F-75015 Paris, France.
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Impact of CPAP on Forehead Near-infrared Spectroscopy Measurements in Patients With Acute Respiratory Failure: Truth or Illusion. J Neurosurg Anesthesiol 2020; 31:406-412. [PMID: 30015697 DOI: 10.1097/ana.0000000000000529] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Critically ill patients with acute respiratory failure admitted to an intensive care unit are at high risk for cerebral hypoxia. We investigated the impact of continuous positive airway pressure (CPAP) therapy on regional cerebral tissue oxygenation (rSO2). MATERIALS AND METHODS In total, 40 extubated surgical intensive care unit patients requiring classic oxygen therapy (COT) for acute respiratory failure were examined. Near-infrared spectroscopy (INVOS 5100C, Covidien) was used for 30 minutes to detect bilateral rSO2 during COT via facemask (6 L/min) and CPAP therapy (40% fraction of inspired oxygen, 8 cm H2O CPAP) using a randomized crossover study design. Patients served as their own control. Continuous hemodynamic routine monitoring and blood gas analysis were performed. The effect of CPAP therapy on rSO2 and influence of assessed covariables were investigated using a mixed linear model. RESULTS Median rSO2 increased from 57.9% (95% confidence interval [CI], 54.2-61.5) during COT to 62.8% (95% CI, 59.2-66.5) during CPAP therapy (P<0.0001). The estimated difference from the mixed model between COT and CPAP is -5.0 (95% CI, -6.3 to -3.7). Median arterial partial pressure of carbon dioxide decreased from 47.8±5.1 mm Hg during COT to 43.1±5 mm Hg during CPAP (P<0.001), whereas arterial partial pressure of oxygen remained unchanged (P=0.329). In total, 23% of patients had SO2 levels <50%, with a higher prevalence under COT. CONCLUSIONS Our results reveal that CPAP therapy compared with COT may influence rSO2 in patients with acute respiratory failure. However, the cause of the rSO2 increase following CPAP application remains to be elucidated, and the accuracy of cerebral oximetry during CPAP therapy in patients with acute respiratory failure remains questionable.
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Tamanyan K, Weichard A, Biggs SN, Davey MJ, Nixon GM, Walter LM, Horne RSC. The impact of central and obstructive respiratory events on cerebral oxygenation in children with sleep disordered breathing. Sleep 2019; 42:5352806. [DOI: 10.1093/sleep/zsz044] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 02/09/2019] [Indexed: 02/02/2023] Open
Affiliation(s)
- Knarik Tamanyan
- The Ritchie Centre, Hudson Institute of Medical Research, Department of Paediatrics, Monash University, Melbourne, Australia
| | - Aidan Weichard
- The Ritchie Centre, Hudson Institute of Medical Research, Department of Paediatrics, Monash University, Melbourne, Australia
| | - Sarah N Biggs
- The Ritchie Centre, Hudson Institute of Medical Research, Department of Paediatrics, Monash University, Melbourne, Australia
| | - Margot J Davey
- The Ritchie Centre, Hudson Institute of Medical Research, Department of Paediatrics, Monash University, Melbourne, Australia
- Melbourne Children’s Sleep Centre, Monash Children’s Hospital, Melbourne, Australia
| | - Gillian M Nixon
- The Ritchie Centre, Hudson Institute of Medical Research, Department of Paediatrics, Monash University, Melbourne, Australia
- Melbourne Children’s Sleep Centre, Monash Children’s Hospital, Melbourne, Australia
| | - Lisa M Walter
- The Ritchie Centre, Hudson Institute of Medical Research, Department of Paediatrics, Monash University, Melbourne, Australia
| | - Rosemary S C Horne
- The Ritchie Centre, Hudson Institute of Medical Research, Department of Paediatrics, Monash University, Melbourne, Australia
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Alex RM, Mousavi ND, Zhang R, Gatchel RJ, Behbehani K. Obstructive sleep apnea: Brain hemodynamics, structure, and function. ACTA ACUST UNITED AC 2017. [DOI: 10.1111/jabr.12101] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Raichel M. Alex
- Department of Bioengineering; University of Texas at Arlington; Arlington TX USA
| | | | - Rong Zhang
- Department of Neurology and Neurotherapeutics; University of Texas Southwestern Medical Center; Dallas TX USA
- Institute for Exercise and Environmental Medicine; Texas Health Hospital Dallas; Dallas TX USA
| | - Robert J. Gatchel
- Department of Psychology; University of Texas at Arlington; Arlington TX USA
| | - Khosrow Behbehani
- Department of Bioengineering; University of Texas at Arlington; Arlington TX USA
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Olmo Arroyo J, Khirani S, Amaddeo A, Griffon L, De Sanctis L, Pouard P, Fauroux B. A comparison of pulse oximetry and cerebral oxygenation in children with severe sleep apnea-hypopnea syndrome: a pilot study. J Sleep Res 2017; 26:799-808. [DOI: 10.1111/jsr.12561] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 04/11/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Jorge Olmo Arroyo
- Pediatric Noninvasive Ventilation and Sleep Unit; AP-HP; Hôpital Necker Enfants-Malades; Paris France
| | - Sonia Khirani
- Pediatric Noninvasive Ventilation and Sleep Unit; AP-HP; Hôpital Necker Enfants-Malades; Paris France
- ASV Santé; Gennevilliers France
| | - Alessandro Amaddeo
- Pediatric Noninvasive Ventilation and Sleep Unit; AP-HP; Hôpital Necker Enfants-Malades; Paris France
- Paris Descartes University; Paris France
- Research Unit INSERM U 955; Team 13; Créteil France
| | - Lucie Griffon
- Pediatric Noninvasive Ventilation and Sleep Unit; AP-HP; Hôpital Necker Enfants-Malades; Paris France
| | - Livio De Sanctis
- Pediatric Noninvasive Ventilation and Sleep Unit; AP-HP; Hôpital Necker Enfants-Malades; Paris France
| | - Philippe Pouard
- Pediatric Cardiac Intensive Care and Anaesthesia Unit; AP-HP; Hôpital Necker Enfants-Malades; Paris France
| | - Brigitte Fauroux
- Pediatric Noninvasive Ventilation and Sleep Unit; AP-HP; Hôpital Necker Enfants-Malades; Paris France
- Paris Descartes University; Paris France
- Research Unit INSERM U 955; Team 13; Créteil France
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Zhang Z, Schneider M, Laures M, Qi M, Khatami R. The Comparisons of Cerebral Hemodynamics Induced by Obstructive Sleep Apnea with Arousal and Periodic Limb Movement with Arousal: A Pilot NIRS Study. Front Neurosci 2016; 10:403. [PMID: 27630539 PMCID: PMC5005379 DOI: 10.3389/fnins.2016.00403] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 08/18/2016] [Indexed: 11/13/2022] Open
Abstract
Obstructive sleep apnea syndrome (OSA) and restless legs syndrome (RLS) with periodic limb movement during sleep (PLMS) are two sleep disorders characterized by repetitive respiratory or movement events associated with cortical arousals. We compared the cerebral hemodynamic changes linked to periodic apneas/hypopneas with arousals (AHA) in four OSA-patients with periodic limb movements (PLMA) with arousals in four patients with RLS-PLMS using near-infrared spectroscopy (NIRS). AHA induced homogenous pattern of periodic fluctuations in oxygenated (HbO2) and deoxygenated (HHb) hemoglobin, i.e., the decrease of HbO2 was accompanied by an increase of HHb during the respiratory event and resolved to reverse pattern when cortical arousal started. Blood volume (BV) showed the same pattern as HHb but with relative smaller amplitude in most of the AHA events.These changing patterns were significant as Wilcoxon signed-rank tests gave p < 0.001 when comparing the area under the curve of these hemodynamic parameters to zero. By contrast, in PLMA limb movements induced periodic increments in HbO2 and BV (Wilcoxon signed-rank tests, p < 0.001), but HHb changed more heterogeneously even during the events coming from the same patient. Heart rate (HR) also showed different patterns between AHA and PLMA. It significantly decreased during the respiratory event (Wilcoxon signed-rank test, p < 0.001) and then increased after the occurrence of cortical arousal (Wilcoxon signed-rank test, p < 0.001); while in PLMA HR first increased preceding the occurrence of cortical arousal (Wilcoxon signed-rank test, p < 0.001) and then decreased. The results of this preliminary study show that both AHA and PLMA induce changes in cerebral hemodynamics. The occurrence of cortical arousal is accompanied by increased HR in both events, but by different BV changes (i.e., decreased/increased BV in AHA/PLMA, respectively). HR changes may partially account for the increased cerebral hemodynamics during PLMA; whereas in AHA probable vasodilatation mediated by hypoxia/hypercapnia is more crucial for the post-arousal hemodynamics. The differences between changes of cerebral hemodynamics and HR may indicate different pathological mechanisms behind these two sleep disorder events.
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Affiliation(s)
- Zhongxing Zhang
- Center for Sleep Medicine and Sleep Research, Clinic BarmelweidBarmelweid, Switzerland
- Bern Network for Epilepsy, Sleep and Consciousness (BENESCO), Department of Neurology, University Hospital Bern, University of BernBern, Switzerland
| | - Maja Schneider
- Center for Sleep Medicine and Sleep Research, Clinic BarmelweidBarmelweid, Switzerland
| | - Marco Laures
- Center for Sleep Medicine and Sleep Research, Clinic BarmelweidBarmelweid, Switzerland
| | - Ming Qi
- Center for Sleep Medicine and Sleep Research, Clinic BarmelweidBarmelweid, Switzerland
| | - Ramin Khatami
- Center for Sleep Medicine and Sleep Research, Clinic BarmelweidBarmelweid, Switzerland
- Bern Network for Epilepsy, Sleep and Consciousness (BENESCO), Department of Neurology, University Hospital Bern, University of BernBern, Switzerland
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Alexandre F, Heraud N, Sanchez AM, Tremey E, Oliver N, Guerin P, Varray A. Brain Damage and Motor Cortex Impairment in Chronic Obstructive Pulmonary Disease: Implication of Nonrapid Eye Movement Sleep Desaturation. Sleep 2016; 39:327-35. [PMID: 26446126 PMCID: PMC4712404 DOI: 10.5665/sleep.5438] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 09/05/2015] [Indexed: 12/14/2022] Open
Abstract
STUDY OBJECTIVES Nonrapid eye movement (NREM) sleep desaturation may cause neuronal damage due to the withdrawal of cerebrovascular reactivity. The current study (1) assessed the prevalence of NREM sleep desaturation in nonhypoxemic patients with chronic obstructive pulmonary disease (COPD) and (2) compared a biological marker of cerebral lesion and neuromuscular function in patients with and without NREM sleep desaturation. METHODS One hundred fifteen patients with COPD (Global Initiative for Chronic Obstructive Lung Disease [GOLD] grades 2 and 3), resting PaO2 of 60-80 mmHg, aged between 40 and 80 y, and without sleep apnea (apnea-hypopnea index < 15) had polysomnographic sleep recordings. In addition, twenty-nine patients (substudy) were assessed i) for brain impairment by serum S100B (biological marker of cerebral lesion), and ii) for neuromuscular function via motor cortex activation and excitability and maximal voluntary quadriceps strength measurement. RESULTS A total of 51.3% patients (n = 59) had NREM sleep desaturation (NREMDes). Serum S100B was higher in the NREMDes patients of the substudy (n = 14): 45.1 [Q1: 37.7, Q3: 62.8] versus 32.9 [Q1: 25.7, Q3: 39.5] pg.ml(-1) (P = 0.028). Motor cortex activation and excitability were lower in NREMDes patients (both P = 0.03), but muscle strength was comparable between groups (P = 0.58). CONCLUSIONS Over half the nonhypoxemic COPD patients exhibited NREM sleep desaturation associated with higher values of the cerebral lesion biomarker and lower neural drive reaching the quadriceps during maximal voluntary contraction. The lack of muscle strength differences between groups suggests a compensatory mechanism(s). Altogether, the results are consistent with an involvement of NREM sleep desaturation in COPD brain impairment. CLINICAL TRIAL REGISTRATION The study was registered at www.clinicaltrials.gov as NCT01679782.
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Affiliation(s)
- Francois Alexandre
- Movement To Health Laboratory, Euromov, University of Montpellier, Montpellier, France
- Clinique du Souffle La Vallonie, Fontalvie, Lodève, France
| | - Nelly Heraud
- Clinique du Souffle La Vallonie, Fontalvie, Lodève, France
- Clinique du Souffle Les Clarines, Fontalvie, Riom-es-Montagnes, France
| | - Anthony M.J. Sanchez
- UMR866 Dynamique Musculaire et Métabolisme, INRA, University of Montpellier, Montpellier, France
- Laboratoire Performance Santé Altitude, EA 4604, University of Perpignan Via Domitia, Font-Romeu, France
| | - Emilie Tremey
- Clinique du Souffle La Vallonie, Fontalvie, Lodève, France
- Clinique du Souffle Les Clarines, Fontalvie, Riom-es-Montagnes, France
| | - Nicolas Oliver
- Clinique du Souffle La Vallonie, Fontalvie, Lodève, France
| | - Philippe Guerin
- Clinique du Souffle Les Clarines, Fontalvie, Riom-es-Montagnes, France
| | - Alain Varray
- Movement To Health Laboratory, Euromov, University of Montpellier, Montpellier, France
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Alexandre F, Heraud N, Varray A. Is nocturnal desaturation a trigger for neuronal damage in chronic obstructive pulmonary disease? Med Hypotheses 2015; 84:25-30. [DOI: 10.1016/j.mehy.2014.11.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 11/03/2014] [Accepted: 11/09/2014] [Indexed: 01/26/2023]
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Ulrich S, Nussbaumer-Ochsner Y, Vasic I, Hasler E, Latshang TD, Kohler M, Muehlemann T, Wolf M, Bloch KE. Cerebral Oxygenation in Patients With OSA. Chest 2014; 146:299-308. [DOI: 10.1378/chest.13-2967] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
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Zhang Q, Ivkovic V, Hu G, Strangman GE. Twenty-four-hour ambulatory recording of cerebral hemodynamics, systemic hemodynamics, electrocardiography, and actigraphy during people's daily activities. JOURNAL OF BIOMEDICAL OPTICS 2014; 19:47003. [PMID: 24781591 DOI: 10.1117/1.jbo.19.4.047003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Accepted: 03/05/2014] [Indexed: 06/03/2023]
Abstract
The feasibility and utility of wearable 24-h multimodality neuromonitoring during daily activities are demonstrated. We have developed a fourth-generation ambulatory near infrared spectroscopy device, namely NINscan 4. NINscan 4 enables recording of brain function (via cerebral hemodynamics), systemic hemodynamics, electrocardiography, and actigraphy simultaneously and continuously for up to 24 h at 250-Hz sampling rate, during (and with minor restriction to) daily activities. We present initial 24-h human subject test results, with example analysis including (1) comparison of cerebral perfusion and oxygenation changes during wakefulness and sleep over a 24-h period and (2) capturing of hemodynamic changes prior, during and after sudden waken up in the night during sleep. These results demonstrate the first ambulatory 24-h cerebral and systemic hemodynamics monitoring, and its unique advantages including long-term data collection and analysis capability, ability to catch unpredictable transient events during activities of daily living, as well as coregistered multimodality analysis capabilities. These results also demonstrate that NINscan 4's motion artifact at 1-g head movement is smaller than physiological hemodynamic fluctuations during motionless sleep. The broader potential of this technology is also discussed.
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Affiliation(s)
- Quan Zhang
- Massachusetts General Hospital, Harvard Medical School Neural Systems Group, 13th Street, Building 149, Room 2651, Charlestown, Massachusetts 02129bCenter for Space Medicine, Baylor College of Medicine, Houston, Texas
| | - Vladimir Ivkovic
- Massachusetts General Hospital, Harvard Medical School Neural Systems Group, 13th Street, Building 149, Room 2651, Charlestown, Massachusetts 02129
| | - Gang Hu
- Massachusetts General Hospital, Harvard Medical School Neural Systems Group, 13th Street, Building 149, Room 2651, Charlestown, Massachusetts 02129
| | - Gary E Strangman
- Massachusetts General Hospital, Harvard Medical School Neural Systems Group, 13th Street, Building 149, Room 2651, Charlestown, Massachusetts 02129bCenter for Space Medicine, Baylor College of Medicine, Houston, Texas
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13
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Schytz HW, Jensen BE, Jennum P, Selb J, Boas DA, Ashina M. Low-frequency oscillations and vasoreactivity of cortical vessels in obstructive sleep apnea during wakefulness: a near infrared spectroscopy study. Sleep Med 2013; 14:416-21. [PMID: 23517585 DOI: 10.1016/j.sleep.2012.12.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2012] [Revised: 11/09/2012] [Accepted: 12/17/2012] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Effective nasal continuous positive airway pressure (CPAP) therapy reduces the cardiovascular outcomes associated with obstructive sleep apnea (OSA), but the mechanism behind this effect is unclear. We investigated if OSA patients during wakefulness showed signs of increased sympathetic activity and decreased vasoreactivity in cerebral cortical vessels as measured with near-infrared spectroscopy (NIRS), and if this may be reversed by CPAP treatment. SUBJECTS AND METHODS 23 OSA patients (mean age, 55y) naive to CPAP were included in a prospective interventional study. The OSA patients received CPAP therapy for at least two months. Cortical low-frequency oscillation (LFO) amplitudes and vasoreactivity during a breath hold test were measured with NIRS and were compared between baseline and after CPAP treatment. Baseline values also were compared to 13 healthy controls (mean age, 52y). RESULTS We found a decrease in LFO amplitudes after CPAP therapy (P=0.022) in OSA patients. We found no differences in LFO amplitudes between OSA patients and healthy controls (P=0.934). There were no differences in peak vascular response following breath hold tests in OSA patients before and after CPAP therapy (P=0.158) or compared to healthy controls (P=0.740). CONCLUSION Our NIRS study revealed a decrease in LFO amplitude following two months of CPAP treatment in OSA patients, which may reflect a decrease in sympathetic activity affecting cortical vessels.
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Affiliation(s)
- Henrik Winther Schytz
- Danish Headache Center and Department of Neurology, Glostrup University Hospital, Glostrup, Denmark
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Pierro ML, Sassaroli A, Bergethon PR, Ehrenberg BL, Fantini S. Phase-amplitude investigation of spontaneous low-frequency oscillations of cerebral hemodynamics with near-infrared spectroscopy: a sleep study in human subjects. Neuroimage 2012; 63:1571-84. [PMID: 22820416 DOI: 10.1016/j.neuroimage.2012.07.015] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2012] [Revised: 05/24/2012] [Accepted: 07/10/2012] [Indexed: 11/25/2022] Open
Abstract
We have investigated the amplitude and phase of spontaneous low-frequency oscillations (LFOs) of the cerebral deoxy- and oxy-hemoglobin concentrations ([Hb] and [HbO]) in a human sleep study using near-infrared spectroscopy (NIRS). Amplitude and phase analysis was based on the analytic signal method, and phasor algebra was used to decompose measured [Hb] and [HbO] oscillations into cerebral blood volume (CBV) and flow velocity (CBFV) oscillations. We have found a greater phase lead of [Hb] vs. [HbO] LFOs during non-REM sleep with respect to the awake and REM sleep states (maximum increase in [Hb] phase lead: ~π/2). Furthermore, during non-REM sleep, the amplitudes of [Hb] and [HbO] LFOs are suppressed with respect to the awake and REM sleep states (maximum amplitude decrease: 87%). The associated cerebral blood volume and flow velocity oscillations are found to maintain their relative phase difference during sleep, whereas their amplitudes are attenuated during non-REM sleep. These results show the potential of phase-amplitude analysis of [Hb] and [HbO] oscillations measured by NIRS in the investigation of hemodynamics associated with cerebral physiology, activation, and pathological conditions.
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Affiliation(s)
- Michele L Pierro
- Department of Biomedical Engineering, Tufts University, Medford, MA, USA.
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Aries MJH, Coumou AD, Elting JWJ, van der Harst JJ, Kremer BPH, Vroomen PCAJ. Near infrared spectroscopy for the detection of desaturations in vulnerable ischemic brain tissue: a pilot study at the stroke unit bedside. Stroke 2011; 43:1134-6. [PMID: 22198984 DOI: 10.1161/strokeaha.111.636894] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE There is uncertainty whether bilateral near infrared spectroscopy (NIRS) can be used for monitoring of patients with acute stroke. METHODS The NIRS responsiveness to systemic and stroke-related changes was studied overnight by assessing the effects of brief peripheral arterial oxygenation and mean arterial pressure alterations in the affected versus nonaffected hemisphere in 9 patients with acute stroke. RESULTS Significantly more NIRS drops were registered in the affected compared with the nonaffected hemisphere (477 drops versus 184, P<0.001). In the affected hemispheres, nearly all peripheral arterial oxygenation drops (n=128; 96%) were detected by NIRS; in the nonaffected hemispheres only 23% (n=30; P=0.17). Only a few mean arterial pressure drops were followed by a significant NIRS drop. This was however significantly different between both hemispheres (32% versus 13%, P=0.01). CONCLUSIONS This pilot study found good responsiveness of NIRS signal to systemic and stroke-related changes at the bedside but requires confirmation in a larger sample.
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Affiliation(s)
- Marcel J H Aries
- University Medical Centre Groningen, Department of Neurology, The Netherlands, Hanzeplein 1, 9700 RB Groningen.
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